Provider Demographics
NPI:1518433812
Name:WEEKS, KAITLIN NICOLE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:WEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 GLORIETTA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3431
Mailing Address - Country:US
Mailing Address - Phone:775-830-6830
Mailing Address - Fax:
Practice Address - Street 1:694 GLORIETTA BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3431
Practice Address - Country:US
Practice Address - Phone:775-830-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801141106OtherEAST BAY ABA